Nurse Licensure Compact Biennial Report FY2018-19

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Nurse Licensure Compact A Biennial Report FY2018-19 i

ICNLCA Core Purpose The Nurse Licensure Compact advances public protection and access to care through the mutual recognition of one statebased license that is enforced locally and recognized nationally.

ICNLCA Mission The mission of the Interstate Commission of Nurse Licensure Compact Administrators (ICNLCA) is to facilitate cross-border nursing practice through the implementation of a nationally recognized, multistate license. ICNLCA enhances nurse mobility and public protection primarily through:

• Maintaining uniform licensure standards among party state boards of nursing; • Promoting cooperation and collaboration between party states; • Facilitating the exchange of data and information between party states; and • Educating stakeholders.

ICNLCA Core Values • Transparency • Integrity • Accountability • Innovation • Collaboration


“Growth is never by mere chance; it is the result of forces

working together.” — James Cash Penney

Letter from the Chair Dear Commissioners, This has been an extraordinary time of growth and change for the Nurse Licensure Compact (NLC). We have grown to 34 states and have seen more states than ever before introduce legislation to join. With the NLC’s current state of evolution, the compact is becoming ever more important. Due to our collective work and continuous collaboration with stakeholders, we continue to lead the way in this groundbreaking work. This year, alone, we have achieved a lot that is worth celebrating. You will see that as you review this report.

Since its beginnings, the work of NLC has been quintessential in helping remove barriers or unnecessary burdens to borderless practice and increasing access to care. Due to overwhelming success, the NLC’s model of mutual recognition has become the model for other health care professions developing interstate licensure compacts. NLC staff have helped to nurture our position as the “expert resource” by providing on-demand information and presentations for other compacts as well as other professions considering a compact. Although positive, growth and change never come without challenge. Undoubtedly, as we continue on our path, we will face many challenges. We have already risen to many of these challenges through the development of our four strategic initiatives. With increased collaboration and dialogue between commissioners, broadening of our strategic thought process, and the implementation of the strategic plan, we will continue to address these and any new challenges that may arise. Looking towards the future, we should be excited about how far we have come and how far we have yet to go! Thank you for the opportunity to serve as your chair for the past two years. Thank you to all NLC commissioners and NLC committee members for all of your efforts, contributions and expertise in helping to achieve NLC growth and success! Sincerely,

Sue Tedford, MNSc, APRN Chair, NLC Commission Fiscal Year 2018-19 1

Nurse Licensure Compact (NLC) Celebrates 19th Anniversary of Regulatory Transformation: 2000–2019 Since its beginnings in 2000, the NLC has provided nurses, RNs and LPNs/VNs with an extraordinary advantage, enabling cross-border practice and remedying the burden of having to obtain licenses in multiple states. Guided by the strategic initiatives and objectives set forth by the Interstate Commission of Nurse Licensure Compact Administrators (ICNLCA), the NLC continues to adapt to change and be recognized as an effective regulatory model that accomplishes the mission to “facilitate crossborder nursing practice through the implementation of a nationally recognized, multistate license.” Beginning on Jan. 19, 2018, an updated version of the NLC was implemented in 26 states, replacing the original version that started in 2000. To date, 34 states have enacted NLC legislation. The “enhanced” version of the NLC (eNLC) improves the compact in a number of areas. Key changes in this updated compact include: •

The addition of uniform licensure requirements for eligibility to obtain a multistate license. They can be viewed here.

A new provision indicating that each state in the NLC require that a nurse applicant for a multistate license submit to state and federal fingerprint-based criminal background checks at initial licensing and license by endorsement.

The establishment of a governing body over the NLC which is known as a commission. The commission is comprised of the executive officers of compact state’s boards of nursing.

The authority for rulemaking by the commission. This ensures uniformity of rules across member states. The rules which are promulgated must be directly related to the NLC statutes. They do not change a member state’s nurse practice act but rather are related to the implementation and operations of the NLC.

Provisions related to compliance and enforcement which relate to a member state’s compliance with compact requirements and the ability to terminate a state’s membership if necessary after all attempts to remedy the issue are exhausted.

“If four things are followed — having great aim, acquiring knowledge, hard work, and perseverance — then anything can be achieved.” — A.P.J. Abdul Kalam 2

With these substantial enhancements and changes, 2018–19 generally had more states introduce compact legislation than ever before! On July 1, 2019, Kansas and Louisiana became the 30th and 31st states to implement the NLC. Congratulations to Commissioners Carol Moreland and the Kansas Board of Nursing, Karen Lyon and the Louisiana State Board of Nursing for Registered Professional Nurses, and Lynn Ansardi and the Louisiana State Board of Practical Nurse Examiners. We thank them for their hard work.

NLC Director, Jim Puente teaches KS BON staff about the NLC.

Furthermore, in 2019 Alabama, Indiana and New Jersey passed legislation to join the NLC, growing the compact to 34 states. Alabama plans to implement on Jan. 1, 2020 and Indiana and New Jersey will be establishing their implementation dates shortly. As we look toward the future, it is vital that the NLC continue to implement its strategic initiatives and assist member boards and key stakeholders with the development of educational resources to promote compact understanding and safe and effective nursing practice.

NLC States NLC States

Continue reading for some of the major highlights of 2018-19.

















































NLC States AL implements on 1/1/20 IN implementation is TBD implementation is TBD AL implements onNJ1/1/20

NLC States

IN implementation is have TBD enacted the NLC 34 states NJ implementation is TBD implemented the NLC 31 states have 3








34 states have enacted the NLC 31 states have implemented the NLC


Strategically Planning for the Future New Logo Following the Jan. 19, 2018 implementation of the eNLC, the ICNLCA directed NCSBN’s marketing and communications department to commission a new NLC logo to highlight and incorporate the historic growth and movement of the NLC. Out of a choice of several logos, the final logo was voted on at the 2018 Annual Meeting of the NLC Commission. The logo selected builds upon the foundation of the previous logo as well as the history of the NLC. The patriotic colors are representative of the NLC as a governmental agency. The circular design is representative of commission unity and collaboration, and the flag is representative of the NLC policy goal of one license, recognized nationally, enforced locally. The logo has been and continues to be incorporated into various NLC public documents and resources.



NLC Strategic Planning In November 2018, NLC engaged consultant Robert Nelson, CAE, to aid in the facilitation and development of a successful NLC strategic plan that will carry the organization through 2022. Nelson brought over a quarter century of successful executive leadership and hands-on experience facilitating the development of complex solutions to complex organizational challenges. The strategic planning session was a two-day meeting that took place in Nashville on Nov. 28–29, 2018, in which 26 commissioners attended and participated. Nelson used a blend of logic, creative thinking, analytics, group work and humor to engage participants in an out-of-thebox thinking session. In May 2019, the NLC Executive Committee met to fine tune the initiatives, outcomes, strategies and tactics of the three-year strategic plan.


Strategic Partner Development and Collaboration

Education of Board and Stakeholders

Marketing and Communications

Comprehensive Evaluation Plan

Tactics of the strategic plan will relate to the four strategic initiatives: •

Strategic Initiative I: Strategic Partner Development and Collaboration

Strategic Initiative II: Education of Board and Stakeholders

Strategic Initiative III: Marketing and Communications

Strategic Initiative IV: Comprehensive Evaluation Plan

The goal is to build the strategic initiatives into a comprehensive commission strategic plan and create an environment permeated by strategic thinking at every level of the NLC. NLC staff continue to build upon tactics that will assist in carrying the plan forward now and into the future. Key elements of the strategic plan involve building and maintaining relationships with new and existing NLC partners, creating new and enhanced educational resources for nurse licensees, nursing regulatory bodies, employers and other key stakeholders, enhancing marketing efforts, as well as enhancing and developing compliance-related educational tools.

Robert Nelson, CAE, facilitates NLC strategic planning meeting in Nashville, TN.


NLC Summit Because of the 2019 Strategic Planning session, NLC commissioners and staff were able to identify additional issues and concerns related to implementation standards. These issues included: •

Philosophy related to the original NLC versus the eNLC

Model consistency; what should the compact look like

Differing expectations and perceptions amongst stakeholders

Due to the complexity of the issues listed above, the NLC Executive Committee decided the best course of action would be to engage NLC commissioners in a two-day Summit on Feb. 22–23, 2019, to come to agreement regarding implementation standards and agreements on key principles related to multistate licensure. To achieve these goals, Dr. Leonard Marcus, director of the Program for Healthcare Negotiation and Conflict Resolution at the Harvard School of Public Health and co-director of the National Preparedness Leadership Initiative, was selected to facilitate the discussion. He began the summit with encouraging and congratulatory words, highlighting the many achievements of the NLC. He continued the discussion with a brief overview of Meta Leadership as a model and framework and by helping to identify the issues of concern, setting expectations and discussing meeting goals. Throughout the Summit, Marcus highlighted, “there was a lot of intense thinking and emotion.” Marcus’ expertise and guidance throughout the process helped commissioners challenge the nuances and complexities associated with growth and change of the compact. As a result, commissioners came to the realization that there was almost unanimous agreement among the group, especially since the overarching goal of all is protection of the public. NLC Commissioners participate in NLC Summit facilitated by Dr. Leonard Marcus.


Louisiana State Board of Nursing celebrates becoming the 31st state to join the NLC.

Legislation As mentioned earlier, 2018-19 marked a year when more states than ever before introduced legislation to join the NLC. A total of 11 states introduced legislation: Alabama, Hawaii, Illinois, Indiana, Massachusetts, Michigan, Minnesota, New Jersey, Pennsylvania, Vermont and Washington. Although the bill did not pass in every state, it is likely that, in the states where the NLC did not pass, legislation will be reintroduced in January of 2020 when legislative session starts again. We have seen tremendous success in Kansas, Louisiana, Alabama, Indiana and New Jersey as they became the 30th, 31st, 32nd, 33rd and 34th states to enact NLC legislation. We also anticipate the possibility of Michigan or Vermont passing legislation either this year or next. Also of note is that regulators and the legislature in Guam are considering becoming the first U.S. territory to introduce NLC legislation. APRN In relation to the APRN Compact, a taskforce was appointed by NCSBN to review the APRN Compact for any necessary revisions. Taskforce recommendations were introduced and discussed at 2019 NCSBN Midyear Meeting. The APRN Compact taskforce continues to work on any necessary revisions to the APRN compact. It is anticipated that the recommendations will be voted on at a future NCSBN Delegate Assembly.


Endorsements and Partnerships 2018-2019 was an impactful year in terms of growing support for the NLC. Various noteworthy organizations have endorsed the NLC. Some noteworthy endorsements include: •

April 2018 marks National Student Nurses’ Association’s Board of Directors’ unanimous vote to endorse the NLC.

May 2018 marks the date that NLC staff received a letter of endorsement for NLC from the Hospital Corporation of America (HCA). HCA is one of the largest hospital systems in the nation. With 177 hospitals located in Alaska, California, Colorado, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nevada, New Hampshire, Oklahoma, South Carolina, Tennessee, Texas, Utah and Virginia.

A full list of current NLC endorsers can be viewed online.

NLC supporters across the U.S. •

Air & Surface Transport Nurses Association

Commission for Case Manager Certification

American Academy of Ambulatory Care Nursing

Cross Country Healthcare

American Association of Colleges of Nursing

Emergency Nurses Association (ENA)

Health IT Now

American Association of Neuroscience Nurses

Hospital Corporation of America (HCA) Healthcare

American Association of Occupational Health Nurses (AAOHN)

National Military Family Association

American Association of Poison Control Centers

National Governors Association Center for Best Practices

National League for Nursing

American Nephrology Nurses Association

National Patient Safety Foundation

American Organization of Nurse Executives (AONE)

National Student Nurses’ Association (NSNA)

American Telemedicine Association (ATA)

Oncology Nursing Society

Association of Camp Nurses


Association for Vascular Access

Organization for Associate Degree Nursing

Case Management Society of America (CMSA)

Population Health Alliance

Telehealth Leadership Council

Center for Telehealth and E-Health Law

U.S. Department of Commerce

CGFNS International, Inc.

WorldWide HealthStaff Solutions Ltd.

Citizen Advocacy Center (CAC) 8

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primar 1. Issued in your residence.

To begin implementation of the strategic plan and continue to enhance the educational offerings related to the NLC, efforts to create and enhance informational materials and fact sheets for various audiences were made throughout the year.

in other states, you 2. When driving that state’s must know and obey road). laws (rules of the in other states, if 3. While driving law, the you violate the state’s driving your state can remove state. privileges in that e your primary chang you When 4. (move) to state of residence state, you need another compact driver’s to apply for that state’son your license. You can drive a certain numformer license for ding on the ber of days (depen license then state). The former becomes invalid. in other states, if 5. While driving laws and you violate the state’s (discipline), the state takes action state that it is reported to the (where you issued your license states can reside). Most home as if you take the same action n in your committed the violatio home state.

Such efforts include:

resources Websites: nursec

Fact Sheets and Other Resources


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to Nursing Care Acro Unlo ss the Na tion ckin gA cce , vis ss t Licensur it w oN eCom ww ursin pact .ncs bn.o gC rg/n are lc o Acr @NurseCom r em pa oss ail n urse the ct com Nat pac ion t@n

An NLC fact sheet for chief nursing officers

An NLC fact sheet for student nurses

An NLC fact sheet for employers

An NLC fact sheet for military and military spouses

Tip of the Week emails sent to nursing boards

An NLC frequently asked questions fact sheet

Tip of the Week email for public audiences, with subscription option

An NLC fact sheet explaining requirements when changing primary state of residence

NLC Prezi presentation created for students that boards of nursing can utilize for educational purposes.

An NLC license by exam flowchart fact sheet

An educational video related to primary state of residence, created by NLC staff

An NLC license by endorsement flowchart fact sheet

An educational video for nursing students, created by NLC staff

A Nursys® reports explainer fact sheet

A fact sheet explaining Nursys® Quick Confirm

An educational video for employers, created by NLC staff

An NLC endorsement infographic

Engagement of external vendor for production of additional videos for nurses and employers. Availability: fall 2019

An NLC call to action flyer for nurses

Website and Online •

The NLC webpage was updated to allow for easier search functionality

The NLC Toolkit page was created and updated as a central location to house all relevant informational resources and tools.

Tip of the Week archive page was created to house various educational

NLC related facts. •

NLC Educational videos were uploaded to website and social media pages.












NLC States ND



























Free monthly NLC employer and nurse webinars are offered to provide an overview of the NLC, update participants on the status of pending legislation, explain Nursys® and Nursys e-Notify®, explain moving requirements in relation to the NLC, and answer key questions.

NLC Presentations and Meetings In collaboration with other compacts and/or other organizations/stakeholders, presentations were provided at: •

Case Management Society of America

American Dental Association

Physical Therapists Compact

New Jersey Board of Nursing Public Meeting

Numerous interviews for newspapers and radio were provided

Council of State Governments

NLC Commissioner, Joey Ridenour (AZ) (second from the left) is a panelist presenter at CSG conference.


NLC Conference Exhibitions NLC staff exhibit, provide education, and answer questions at the following exhibits: •

American Organization of Nurse Executives Annual Meeting

National Student Nurses’ Association Midyear Meeting

National Student Nurses’ Association Annual Meeting

American Nurses Association Annual Meeting

National Council of State Legislators Summit

National Rural Health Association

Society of Human Resource Management Annual Meeting

Case Management Society of America Annual Meeting

American Society for Healthcare Human Resources Administration Conference

Staffing World

National Association for Health Care Recruitment

American Telemedicine Association

NLC Board of Nursing Training

NLC staff exhibit at Iowa Student Nurses Association’s Annual Conference (pictured above) and students show support for the NLC at the National Student Nurses’ Association (pictured below).

NLC training sessions continue to be offered at boards of nursing that have welcomed a new executive officer at the helm or a state that has newly joined the NLC. This year, two-day educational sessions were held at the following boards of nursing. •

Alabama Board of Nursing

Louisiana State Board of Nursing

Alaska Board of Nursing

New Mexico Board of Nursing

Colorado Board of Nursing

Oklahoma Board of Nursing

Florida Board of Nursing

South Carolina Board of Nursing

Georgia Board of Nursing

Utah State Board of Nursing

Guam Board of Nurse Examiners

Indiana State Board of Nursing

West Virginia Board of Examiners for Licensed Practical Nurses

Iowa Board of Nursing

Kansas State Board of Nursing

West Virginia Board of Examiners for Registered Professional Nurses

Kentucky Board of Nursing

Wyoming State Board of Nursing


December 19, 2019 Jim Puente Director, NLC

This is to certify that the Annual Audit of the National Council of State Boards of Nursing (“NCSBN”), which was performed by a certified public accountant, incudes all receipts and disbursement of funds handled on behalf of the Interstate Commission of Nurse Licensure Compact Administrators (“ICNLCA”) by NCSBN. Robert Clayborne Chief Financial Officer

Robert Clayborne

Digitally signed by Robert Clayborne Date: 2019.12.19 09:48:07 -06'00'


Financial Summary Fiscal Years 2018–2019 FY18


Revenue Annual Assessments



Total Revenue







Total Expenses



Surplus (Deficit)



$442, 829


Expense MOU Fee with NCSBN Legal Fees*

Cash Balance at June 30

*NLC Commission assumed legal fees in December 2018

Prepared by: Ann Oertwich, PhD, MSN, RN Treasurer, NLC Commission Commissioner, Nebraska Board of Nursing



Highlights from the Nurse Licensure Compact (NLC) Commission Annual Meeting Aug. 20, 2019 | Swissotel | Chicago



Staff to the Commission Jim Puente Director

Maggie Bieniek Sr. Coordinator

Special Counsel to the Commission Richard Masters The General Counsel provides guidance to the Commission and its Committees with respect to legal issues, related to the duties and responsibilities under the NLC terms, its bylaws, and rules. Special Counsel also advises the Commission on issues pertaining to compliance and enforcement responsibilities.


Organizational Chart Interstate Commission of Nurse Licensure Compact Administrators

Director, NLC

Executive Committee

Special Counsel

Standing Committees

Special Committees

Compliance Committee

Training and Education Committee

Elections Committee

Operations Committee

Rules Committee

Policy Committee

Sr. Coordinator, NLC

The Interstate Commission of Nurse Licensure Compact Administrators is a quasi-governmental joint public agency of the party states. ICNLCA staff and services are provided via a memorandum of understanding with NCSBN.

Updated 3/12/2019


Thank you to all NLC Committees and Committee Members Executive Committee Sue Tedford, Arkansas, chair (Term: October 2017–September 2019) Stacey Pfenning, North Dakota, vice-chair (Term: October 2018–September 2020) Ann Oertwich, Nebraska, treasurer (Term: October 2018–September 2020) Kim Glazier, Oklahoma, member-at-large (Term: October 2017–September 2019) Joe Baker, Jr., Florida, member-at-large (Term: October 2018–September 2019) Phyllis Polk Johnson, Mississippi, member-at-large (Term: October 2018–September 2020) Executive Committee

Rules Committee Joey Ridenour, Arizona, co-chair Brett Thompson, Mississippi, co-chair Fred Knight, Arkansas, general counsel Kim Esquibel, Maine (not pictured) Michelle Mayhew, West Virginia-LPN Carol Moody, South Carolina Debbie McKinney, Oklahoma Stacey Pfenning, North Dakota Rick Masters, special counsel Rules Committee 18

Training and Education Committee

Policy Committee

Kim Glazier, Oklahoma, chair

Amy Fitzhugh, North Carolina, chair

Ann Oertwich, Nebraska, vice-chair

Adrian Guerrero, Kansas

Tony Graham, North Carolina

Pam Zickafoose, Delaware

Lisa Hastings, Wyoming

Joe Baker, Jr. Florida

Erin Matthies, South Dakota

Stacey Pfenning, North Dakota

Shan Montgomery, Mississippi

Compliance Committee

Operations Committee

Fred Knight, Arkansas, chair

Mark Majek, Texas, chair

Melissa Hanson, North Dakota

Sue Painter, West Virginia-RN, co-chair

Megan Hudson, Maine

Jeff Busjahn, Utah

Jim Cleghorn, Georgia

Melissa McDonald, North Carolina

Lori Scheidt, Missouri

Darcy Hammond, Oklahoma

Jackye Ward, Oklahoma

Elections Committee Cynthia LaBonde, Wyoming, co-chair Sasha Poole, New Mexico, co-chair

Retirements and Transitions Thank you to the following NLC commissioners for all of the many contributions, service and dedication to the NLC. We congratulate you and wish you all the best in your retirement. Paula Schenk, MPH, RN, retired from the Kentucky Board of Nursing, effective March 31, 2018. Schenk’s retirement marks the culmination of nearly 27 years of service to the board, including several years of service as executive director. Denise Nies, MSN, RN, BC, executive officer of the New Hampshire Board of Nursing retired from state service officially on July 18, 2019.

Sandra Evans, MAEd, RN, retired in January 2019, after 28 years of service to the Idaho State Board of Nursing, which included 22 years serving as the executive director. Demetrius Cianci Chapman, executive officer of the New Mexico Board of Nursing retired from state service officially in 2018.


Sam Delp was promoted within the Colorado Department of Regulatory Agencies. Dan Williams, executive officer of the Wisconsin Board of Nursing retired from state service officially in July 2018.

Thank you to all NLC Commissioners for all you do on behalf of the NLC Alabama Board of Nursing Peggy Benson

Maine State Board of Nursing Karen EB Evans

Tennessee State Board of Nursing Elizabeth Lund

Arizona State Board of Nursing Joey Ridenour

Mississippi Board of Nursing Phyllis Johnson

Texas Board of Nursing Katherine Thomas

Arkansas State Board of Nursing Sue Tedford

Missouri State Board of Nursing Lori Scheidt

Utah State Board of Nursing Jeff Busjahn

Colorado Board of Nursing Lori Bratton

Montana Board of Nursing Melissa Poortenga

Virginia Board of Nursing Jay P. Douglas

Delaware Board of Nursing Pamela C. Zickafoose

Nebraska Board of Nursing Ann Oertwich

West Virginia Board of Examiners for Registered Professional Nurses Sue Painter

Florida Board of Nursing Joe Baker, Jr.

New Hampshire Board of Nursing Bonnie Crumley Aybar

Georgia State Board of Nursing Jim Cleghorn

New Jersey Board of Nursing Joanne Leone

Idaho Board of Nursing Russ Barron

New Mexico Board of Nursing Sasha N. Poole

Indiana State Board of Nursing Toni Herron

North Carolina Board of Nursing Julia George

Iowa Board of Nursing Kathy Weinberg

North Dakota Board of Nursing Stacey Pfenning

Kansas State Board of Nursing Carol Moreland

Oklahoma Board of Nursing Kimberly Glazier

Kentucky Board of Nursing Jessica Estes

South Carolina Board of Nursing Carol Moody

Louisiana State Board of Nursing for Registered Professional Nurses Karen Lyon

South Dakota Board of Nursing Gloria Damgaard


West Virginia State Board of Examiners for Licensed Practical Nurses Michelle Mayhew Wisconsin Board of Nursing Peter Kallio Wyoming State Board of Nursing Cynthia LaBonde

For more information about the Nurse Licensure Compact (NLC), contact: Kim Glazier, MEd, RN Chair, NLC Jim Puente Director, NLC National Council of State Boards of Nursing (NCSBN) 312.525.3601 Maggie Bieniek Senior Coordinator, NLC NCSBN 312.525.3779 Author: Maggie Bieniek Senior Coordinator, NLC


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